Guidelines for prenatal genetic testing recommend that patients receive detailed information to allow informed, preference-based screening and diagnostic testing decisions. In a randomized trial that enrolled 710 demographically diverse pregnant women, Kuppermann and colleagues found that compared with usual care, access to a computerized, interactive prenatal testing decision support guide—providing information and values clarification exercises—and elimination of any out-of-pocket costs associated with prenatal diagnostic testing resulted in less prenatal test use and more informed and preference-based prenatal testing decisions. In an Editorial, Dolan discusses the promise and challenges of personalized prenatal genetic testing.
Author Video Interview
To examine long-term trends in the prevalence and incidence of diagnosed diabetes in US adults, Geiss and colleagues analyzed data from nearly 665 000 adults who participated in the 1980-2012 National Health Interview Surveys. The authors report their analyses suggest an overall plateauing of prevalence and incidence of diagnosed diabetes since 2008. However, among certain subgroups, including non-Hispanic blacks, Hispanics, and persons with less than a high school education, continued increases in prevalence and incidence were observed.
Positron emission tomography (PET) with fludeoxyglucose F 18 (FDG) is recommended for the noninvasive diagnosis of pulmonary nodules suspicious for lung cancer. However, data suggest FDG-PET may not accurately identify malignant lesions in populations with endemic infectious lung disease. In a systematic review and meta-analysis of data from 70 studies of lung cancer diagnosis using FDG-PET, Deppen and colleagues found FDG-PET accuracy was quite heterogeneous and diagnostic specificity was lower in endemic infectious lung disease populations.
Checchi and colleagues assessed whether electronic medication packaging devices improve medication adherence in a systematic review and analysis of data from 37 studies examining the effectiveness of these devices. The authors found that there are many varieties of electronic medication packaging devices and note that data supporting their use are limited. The authors report that devices integrated into the care delivery system and those with audible reminder alarms that are designed to record dosing events were most frequently associated with improvements in medication adherence.
Continuing Medical Education
Lung cancer is the leading cause of cancer mortality in the United States. This JAMA Clinical Guidelines Synopsis article summarizes the 2014 US Preventive Services Task Force recommendations relating to lung cancer screening of asymptomatic adults aged 55 to 80 years who have a 30 pack-year smoking history and currently smoke or have quit smoking within the past 15 years. In an Editorial, Sox discusses concerns about implementing lung cancer screening in Medicare-aged patients. An Editorial by Cifu and colleagues introduces this new JAMA series.
Editorials 1 and 2 and Related Article
A man with a history of travel to the Venezuelan rainforest presented with an erythematous plaque on the neck and erythema and swelling of the left nasal ala with disruption of the nasal architecture and crusting of the naris. Treatment over the past 3 months with a variety of oral, intramuscular, and topical antibiotics had not been beneficial. Biopsy of the nasal tissue revealed reactive hyperplasia and inflammation; no organisms were found using special stains. What would you do next?
Highlights. JAMA. 2014;312(12):1173-1175. doi:10.1001/jama.2013.279739